NHS dental costs will hit £5.3 billion as older adults carry the burden

By Dr. Liji Thomas, MDReviewed by Lauren HardakerJun 15 2026

As the UK population ages, new modeling shows that dental disease costs will increasingly concentrate among older adults, raising fresh questions about whether NHS dentistry is investing early enough in prevention.

Study: Estimating the direct healthcare costs of oral diseases in the United Kingdom: a cost-of-illness projection to 2050. Image Credit: crystal light / Shutterstock

Oral diseases are an umbrella term for several chronic conditions that are very common in both children and adults. A recent study published in the journal Frontiers in Public Health estimated that, by 2050, direct NHS dental treatment costs associated with adult dental caries and periodontal disease-related conditions will rise by 20%, to £5.30 billion.

Background

Oral diseases include periodontal disease, tooth loss, and dental caries, and already carry a significant healthcare cost burden. As the global population ages, the prevalence of these conditions is predicted to rise significantly. For instance, by 2050, untreated dental caries could rise by 75.2% and severe periodontal pocketing by 56.7% compared to 2020 rates, within the UK.

The UK adult population aged 60 years and over numbered 16.9 million in 2020 and is projected to reach 22.5 million by 2050. About 21% of dentate adults have at least one badly decayed tooth, and nearly half reported occasional or frequent oral health impacts, according to the most recent Adult Oral Health Survey (AOHS). Oral health costs comprised 1.5% of the total expenditure on health in the UK in 2018, at over €3.5 billion. However, future estimates remain sparse.

The current study aimed to predict age- and severity-stratified estimates of direct NHS dental treatment costs for adult dental caries and periodontal disease-related conditions by 2050. Population projections, disease prevalence data, and treatment costs were combined to estimate future direct healthcare spending.

The investigators used a cost-of-illness (COI) model based on factors such as the cost per course of treatment, age-specific attendance at dental clinics from the AOHS, and the predicted number of treatment courses required for each age group.

Each treatment type was costed in Units of Dental Activity (UDA). Pediatric dental care and oral cancers were excluded.

20% Increase in Direct NHS Dental Costs

The total cost of treatment for dental caries, periodontal pocketing, and loss of attachment (LOA, loss of periodontal tissue) was estimated to rise from £4.42 billion in 2020 to £5.30 billion in 2050.

Dental Caries, Fastest Cost Growth

Dental caries costs would account for the largest increase, growing by 29% to £1.46 billion, nearly a third of the total. Of this, almost a third would be due to untreated dental caries in adults aged 60 years and over.

The single biggest component of caries costs, however, would come from routine checkups for people without caries, due to population growth. These costs were included in the total projected estimate because the model accounted for all dental activity associated with modeled oral health states, not just treatment procedures.

The costs of treating caries in the 16-59-year age group would decrease during this period, as would the costs of untreated caries in the 16-24-year age group. This would mitigate the increase in older people to some extent.

Urgent care costs were predicted to rise by 26%, accounting for 2% of the total. The largest single urgent-care component would come from untreated caries in adults aged 60 years and over, at £0.03 billion, representing a 168% increase.

Periodontal Pocketing, Largest Cost Share

The costs related to periodontal pocketing are expected to account for the single largest share at £2.16 billion in 2050, a 20% increase. Most of this will be spent on mild pocketing, with a 9% increase from 2020 levels. Conversely, moderate pocketing costs will decrease by 21%, at about £0.13 billion. Severe pocketing treatment costs will rise by 57% over this period, to about £0.81 billion.

LOA Costs

LOA treatment costs are predicted to rise by 13%, to £1.56 billion, mostly due to mild LOA, with a 16% increase to £0.99 billion.

In sensitivity analysis, total projected costs were most sensitive to the UDA contract value.

Implications for Dental Care Policies

The authors report producing the first COI projection for direct NHS healthcare spending on oral diseases in the UK using national parameters and stratified by disease subtype. The estimates differ significantly from those of the most recent research, the authors say, probably due to differences in methodology.

That is, the earlier study used only costs specifically described as being for each disease subtype. The current authors, however, consider that this approach will underestimate disease costs and, therefore, capture all costs by disease type rather than treatment code.

The estimates suggest that costs will rise disproportionately among the elderly and those with more severe disease as a result of the aging of the UK population. The authors suggest that severe oral disease may become more common among the elderly as competing, more urgent healthcare needs tend to delay preventive dental care.

Currently, the UK focuses on treating dental disease in older adults in institutions or care homes rather than prevention, unlike the policy for children. According to the authors, this indicates the need for broader preventive care for older adults to reduce future treatment costs.

“This study provides the economic rationale that future policy needs to focus on taking the direction of the prevention of poor oral health over reactive treatment and intervention.” Programs like Mouth Care Matters demonstrate that better oral health provision in hospitals can improve care and produce health system savings.

Comparable Cost Pressures Across Healthcare Areas

The increase in dental healthcare costs is lower than, but comparable to, projected cost growth for several other chronic diseases, many of which are also influenced by population aging. By comparison, direct costs of cardiovascular disease were estimated at £16.62 billion in the UK in 2021/22. Separate England-based projections estimated cost increases from 2018 to 2050 of 40% for cancer, 54% for coronary heart disease, 100% for dementia, and 85% for stroke. Chronic kidney disease had estimated direct NHS costs of £1.4 billion, and diabetes had estimated direct costs of £10.7 billion in previous studies.

Study Limitations

The study has several limitations, such as extrapolating the NHS dental band system from England to the whole of the UK. With dental care reforms, the differences between various UK regions will probably widen. Similarly, several assumptions were made, including uniform attendance across disease severity, the lack of data on urgent care attendance rates, and linear interpolation between available disease-prevalence time points.

Conclusions

The NHS should plan for dental care that considers the growing treatment burden among older adults, which requires economic planning for preventive care and early treatment. Policymakers will need to factor in indirect costs, such as productivity losses and reductions in quality of life due to these illnesses, making a head-to-head comparison difficult.

However, adult dental caries and periodontal disease-related conditions will make up a significant component of future NHS dental treatment costs. Prevention of oral disease is especially important because many oral diseases are largely preventable but impose a heavier economic burden when advanced.

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